24 September 2008

It's old -- almost two weeks old, which makes it paleolithic by blogosphere standards, but Dean Ornish had a great article in Newsweek titled "The Collapse of Primary Care."

While nothing in the article is new or surprising to readers of this blog (or Kevin's), it's cogent and well-written, and I think of significance because it shows how the, well, the impending collapse of primary care in the US is percolating up to the forefront of the public consciousness. A groundswell of consensus opinion that the system is broken and needs to be fixed is a necessary precondition for fundamental reform.

2 comments:

Its a great article for which I can testify to be true: I was discouraged from entering medicine by more senior MD's, and noticed most US grads with whom I spoke aimed near exclusively for highly paid specialties (while FMG's aimed for FP, IM, Peds, Psych spots.) I, however, dont fault people for wanting to make a good living but do agree the reimbursement process is skewed.

In recent times, others have appeared to express concern about the apparent shortage of primary care doctors in the United States. Both presently as well as in the years to come, others speculate that the shortage of primary care doctors will continue to progress to even greater absence of PCPs that what exists now. Less than 20 percent of medical school graduates go for primary care as a specialty as a residency program today, it has been reported. Typically, the main reason believed by many is lack of pay compared with other medical specialties. Some anticipate a shortage of 60 thousand or so primary care doctors in the future within the United States. The PCP doctors who practice right now would not recommend their specialty, or their profession, it has been reported. I believe their value as PCPs has not been acknowledged to them as it should, nor is there income where it should be for what they do.It is estimated that the U.S. needs presently tens of thousands more primary care physicians to fully satisfy the necessities of those members of the U.S. public health- the U.S. citizens. Ironically, PCPs have been determined to be and likely are the backbone of the U.S. Health care system- they are specialists of everything medically. For example, PCPs manage the many chronically ill patients, who benefit the most from the much needed coordination and continuity of care that PCPs historically have strived to provide for them. Nearly half of the U.S. population has at least one chronic illness- with many of those having more than one of these types of these illnesses. A good portion of these very ill patients have numerous illnesses that are chronic, and this is responsible for well over 50 percent of the entire Medicare budget, who are largely cared and treated by PCPs. The shortage of primary care physicians is possibly due to other variables as well- such as administrative hassles that are quite vexing for the physician vocation overall- along with ever increasing patient loads that is complicated by the progressively increasing cost to provide care for their patients due to decreasing reimbursements from various organizations the doctors receive for the services they provide. For reasons such as this, it is believed that some PCPs are retiring early, or simply seeking an alternative career path. As mentioned earlier, the PCP specialty is not desirable choice for a late stage medical student, so this is quite concerning to the public health in the United States. The number of medical school graduates entering family practice residencies has decreased by about half over the past decade or so. PCPs also have extensive student loans from their training to complicate their rather excessive workloads as caregivers with decreased pay, so I can understand if they are a bit demoralized.Despite the shortage of these doctors, primary care physicians do in fact care for the populations they serve and are dedicated to their welfare and restoration of their health, as difficult as it may be for them at times. Studies have shown that mortality rates would decrease due to increased patient outcomes if there were more PCPs to serve those in need of treatment. This specialty would also optimize preventative care more for their patients. Studies have also shown that, if enough PCPs are practicing in a given geographical area, hospital admissions are decreased, as well as visits to emergency rooms. This is due to the ideal continuity in health care these PCPs provide if numbered correctly to serve a given population of citizens. In addition, PCP care has proven to improve the quality of care given to patients, as well as the outcomes for these patients as a result are more favorable. Most importantly, the overall quality of life for their patients is much improved if there are enough PCPs to handle the overwhelming load of responsibility they presently have due to this shortage of their specialty that is suppose to increase mildly if at all in the years to come. The American College of Physicians believes that a patient- centered national health care workforce policy is needed to address these issues that would ideally be of most benefit for the public health. Policymakers should take this into serious consideration. “In nothing do men more nearly approach the Gods then in giving health to men.” --- Cicero Dan Abshear (ex-military medic and physician assistant for nearly 20 years)Author’s note: What has been written has been based upon information and belief of a layperson, yet also the assessments of a patient.

Shadowfax

About me: I am an ER physician and administrator living in the Pacific Northwest. I live with my wife and four kids. Various other interests include Shorin-ryu karate, general aviation, Irish music, Apple computers, and progressive politics. My kids do their best to ensure that I have little time to pursue these hobbies.

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